scholarly journals Efficacy and Safety Evaluation of Transurethral Resection of the Prostate versus Plasmakinetic Enucleation of the Prostate in the Treatment of Massive Benign Prostatic Hyperplasia

2021 ◽  
pp. 1-8
Author(s):  
Jian Zhang ◽  
Yonghui Wang ◽  
Shuang Li ◽  
Shipeng Jin ◽  
Shiqing Zhang ◽  
...  
Keyword(s):  
Benign Prostatic Hyperplasia ◽  
Clinical Efficacy ◽  
Transurethral Resection ◽  
Statistical Difference ◽  
Operation Time ◽  
Hemoglobin Concentration ◽  
Prostatic Hyperplasia ◽  
Urinary Flow ◽  
Significant Statistical Difference ◽  
Aging Men

<b><i>Background:</i></b> Benign prostatic hyperplasia (BPH) is a common chronic progressive disease resulting in urinary obstruction in aging men. It comes to more and more patients with massive BPH with the aging of society and extension of life expectancy. <b><i>Objective:</i></b> The aim of the study was to compare the clinical efficacy, safety, and complications between transurethral bipolar plasmakinetic enucleation of the prostate (PKEP) and transurethral resection of the prostate (TURP) in the treatment of massive BPH. <b><i>Design and Setting:</i></b> Patients with BPH were divided into the PKEP group and the TURP group randomly. Intraoperative blood loss (BL), operation time (OT), resected tissue weight (RTW), gland resection ratio (GRR), postoperative indwelling ureter time (IUT), bladder fistula time (BFT) and hospital stay time (HST), preoperative and postoperative serum sodium concentration (SSC), hemoglobin concentration (HGB), prostate weight (PW), postvoid residual (PVR), maximum urinary flow rate (<i>Q</i><sub>max</sub>), international prostate symptom score (IPSS), quality of life (QOL), International Index of Erectile Function (IIEF), and other complications were analyzed and compared respectively. <b><i>Results:</i></b> There was no statistical difference in preoperative IPSS, preoperative QOL score, preoperative PVR, preoperative <i>Q</i><sub>max</sub>, postoperative QOL score, postoperative PVR, postoperative <i>Q</i><sub>max</sub>, IPSS difference value (DV), <i>Q</i><sub>max</sub> DV, and PVR DV between the PKEP group and the TURP group (<i>p</i> &#x3e; 0.05). OT, BL, IUT, BFT, HST, and postoperative IPSS in the PKEP group were significantly lower than that in the TURP group (<i>p</i> &#x3c; 0.01). RTW and GRR in the PKEP group were significantly higher than that in the TURP group (<i>p</i> &#x3c; 0.01). QOL DV in the PKEP group was higher than that in the TURP group (<i>p</i> &#x3c; 0.05). There was statistical difference in SSC DV between the PKEP group and the TURP group (<i>p</i> &#x3c; 0.05). There was significant statistical difference in postoperative PW, postoperative HGB, PW DV, and HGB DV between the PKEP group and the TURP group (<i>p</i> &#x3c; 0.01). There was significant statistical difference in IPSS, QOL, PVR, and <i>Q</i><sub>max</sub> between postoperative value and preoperative value in both groups (<i>p</i> &#x3c; 0.01). The incidence of transurethral resection syndrome, obturator nerve reflex, transient urinary incontinence, and retrograde ejaculation between the PKEP group and the TURP group has no statistical difference (<i>p</i> &#x3e; 0.05). Capsule perforation, blood transfusion, secondary hemorrhage, bladder neck contracture, and urethral stricture in the PKEP group were lower than that in the TURP group (<i>p</i> &#x3c; 0.05). Bladder spasm in the PKEP group was significantly lower than that in the TURP group (<i>p</i> &#x3c; 0.01). There was no statistical difference in preoperative and postoperative IIEF-5, effective erectile frequency, telotism average tension, sustainable telotism average time, and sexual dissatisfaction between the PKEP group and the TURP group (<i>p</i> &#x3e; 0.05). <b><i>Conclusions:</i></b> PKEP and TURP have similar clinical efficacy in the treatment of massive BPH. PKEP has advantages in shorter OT, less BL, more GRR, and fewer complications, but the long-term therapeutic effect of PKEP needs further follow-up.

scholarly journals Efficacy and safety of Finasteride (5 alpha-reductase inhibitor) monotherapy in patients with benign prostatic hyperplasia: A critical review of the literature

2020 ◽  
Vol 91 (4) ◽  
pp. 205-210
Author(s):  
Gian Maria Busetto ◽  
Francesco Del Giudice ◽  
Daniele D'Agostino ◽  
Daniele Romagnoli ◽  
Andrea Minervini ◽  
...  
Keyword(s):  
Clinical Trials ◽  
Benign Prostatic Hyperplasia ◽  
Adverse Events ◽  
Clinical Efficacy ◽  
Critical Review ◽  
Reductase Inhibitor ◽  
Prostate Volume ◽  
Prostatic Hyperplasia ◽  
Urinary Flow ◽  
Efficacy And Safety

Background: Combination therapy with 5 alpha-reductase inhibitor (5-ARI) and alpha-blocker can be considered as a gold standard intervention for medical management of lower urinary tract symptoms related to benign prostatic hyperplasia (LUTS/BPH). On the other hand, 5-ARI monotherapy and in particular Finasteride alone is currently getting focus of attention especially due to lack of systematic reviews investigating efficacy outcomes and/or adverse events associated. Objectives: Aim of the present critical review was to analyze current knowledge of clinical efficacy and incidence of adverse events associated with 5-ARI treatment for LUTS/BPH. Materials and methods: A systematic review of clinical trials of the literature of the past 20 years was performed using database from PubMed, Cochrane Collaboration and Embase. A total of 8821 patients were included in this study and inclusion criteria for studies selection were: data from randomized clinical trials (RCTs) focusing their attention on the clinical role of Finasteride monotherapy for symptomatic BPH. Parameters of research included prostate specific antigen (PSA), prostate volume (PV), International Prostate Symptom Score (IPPS), postvoid residual urine (PVR), voiding symptoms of IPSS (voiding IPSS), maximum urinary flow rate (Qmax), and adverse events (AEs). Results: Overall 12 original articles were included and critically evaluated. Sample sizes of patient actively treated with finasteride varied from 13 to 1524 cases analyzed in a single study. Follow-up after treatments ranged from 3 to 54 months. The effect of finasteride in reducing prostate volume (PV) was moderate (standardized mean difference (SMD) effect between 0.5 to 0.8 for all trials evaluable) while the effect on IPSS score and Qmax was considered significant (SMD in the 0.2 to 0.5 variation range). No severe AEs and/or psychiatric disorders were retrieved among the studies. Sexual health dysfunctions were significantly influenced by finasteride therapy when compared with placebo treated patients. Conclusions: Although significant clinical benefits of finasteride monotherapy were demonstrated, the effective size of the available reports included in the analysis is limited. Additional head-to-head studies would be needed to re-evaluate clinical efficacy and safety of 5-ARI in combination or not with alpha blockers.

scholarly journals Plasmakinetic vaporization versus plasmakinetic resection to treat benign prostatic hyperplasia: A prospective randomized trial with 1 year follow-up

2014 ◽  
Vol 8 (9-10) ◽  
pp. 595 ◽  
Author(s):  
Mert Ali Karadag ◽  
Kursat Cecen ◽  
Aslan Demir ◽  
Ramazan Kocaaslan ◽  
Fatih Altunrende
Keyword(s):  
Benign Prostatic Hyperplasia ◽  
Statistical Difference ◽  
Preoperative Evaluation ◽  
Operation Time ◽  
Maximum Flow ◽  
Prostatic Hyperplasia ◽  
Group 2 ◽  
Hemoglobin Drop ◽  
Group 1

Introduction: We evaluate the efficacy and outcomes of plasmakinetic vaporization (PKVP) and plasmakinetic resection (PKR) to treat benign prostatic hyperplasia (BPH).Methods: A total of 183 patients with BPH underwent plasmakinetic prostatic surgery between 2008 and 2012 at Kars State Hospital and Kafkas University Faculty of Medicine, Turkey. After clinical and preoperative evaluation, the patients were randomized to PKRP or PKVP groups sequentially by using computer-generated numbers. Group 1 included 96 patients treated with PKR. Group 2 included 87 patients treated with PKVP. Patients in both groups were compared in terms of hemoglobin drop, operation time, catheter duration, reobstruction, incontinence and recatheterization.Results: When we compared the maximum flow rates (Qmax values) at the 12th month, there was no statistical difference between 2 groups. Group 1 had a mean Qmax value of 17.92 ± 3.819 and Group 2 had a 18.15 ± 3.832 value (p > 0.05). There was a statistical difference between the groups in terms of hemoglobin drop, catheter duration and operation time. The mean catheter duration in Group 1 was 3.74 ± 1.049 days, and in Group 2 it was 2.64 ± 0.849 days (p < 0.05). Operation time was statistically longer in Group 2 (PKVP) and hemoglobin drop was statistically higher in Group 1 (PKR).Conclusion: PKVP for BPH is safe and effective. When compared with PKRP, it provides a significantly shorter catheter duration and less bleeding due to hemostasis control with similar IPSS and Qmax improvements after 1 year.

scholarly journals Spontaneous prostatic haematoma in a case of benign prostatic hyperplasia

2019 ◽  
Vol 12 (3) ◽  
pp. e228787
Author(s):  
Devanshu Bansal ◽  
Amlesh Seth
Keyword(s):  
Benign Prostatic Hyperplasia ◽  
Urinary Bladder ◽  
Urinary Retention ◽  
Transurethral Resection ◽  
Obstructive Uropathy ◽  
Prostatic Hyperplasia ◽  
Urinary Flow ◽  
Urethral Catheterisation ◽  
Definitive Surgery

A 61-year-old man presented with urinary retention with obstructive uropathy (urea/creatinine: 126/9.2 mg/dL) secondary to a large prostatic haematoma while being medically managed for benign enlargement of the prostate. The patient did not have any fever or local symptoms and the prostate was enlarged and non-tender on examination. Ultrasound and MRI of the pelvis showed a 9.4×10.4×11.1 cm sized prostatic haematoma seen displacing and compressing the urinary bladder anteriorly with bilateral hydroureteronephrosis. The patient was managed with per-urethral catheterisation, haemodialysis and injectable antibiotics. Percutaneous pigtail placement into the prostatic haematoma led to gradual drainage of the haematoma with improvement in the renal parameters. Definitive surgery in the form of transurethral resection of the prostate was done at a later date. Intraoperatively multiple encapsulated cavities containing organised clots were deroofed. On follow-up, the patient did well and had good urinary flow and normal renal parameters.

scholarly journals Effects of Transurethral Resection of Prostate (TURP) on Quality of Life in Case of Benign Prostatic Hyperplasia

2019 ◽  
Vol 5 (2) ◽  
pp. 143-147
Author(s):  
Md Abul Hossain ◽  
Md Akter Alam ◽  
Md Fazal Naser ◽  
Md Shafiqul Azam
Keyword(s):  
Quality Of Life ◽  
Benign Prostatic Hyperplasia ◽  
Flow Rate ◽  
Transurethral Resection ◽  
Prostatic Hyperplasia ◽  
Urinary Flow Rate ◽  
Transurethral Resection Of Prostate ◽  
Urinary Flow

Background: BPH is one of the most common cause of LUTS which significantly impairs the quality of life. TURP is minimally invasive surgical procedure for Benign Prostatic hyperplasia which has impact on quality of life. Impact on quality of life can be measured by QoL score and effect of TURP can be evaluated. Objective: The purpose of the present study was to evaluate the impact of transurethral resection of prostate (TURP) on Quality of Life (QoL) score. Methodology: This prospective study was carried out in the Department of Urology, Shaheed Suhrawardy Medical College and Hospital, Dhaka, from July 2015 to June 2016. Total fifty patients between 50 to 72 years attending for the treatment of benign prostatic hypertrophy (BPH) with lower urinary tract symptoms (LUTS) were included for the study according to inclusion & exclusion criteria. All of them were evaluated with baseline international prostate symptoms score (IPSS), QoL score, peak urinary flow rate (Qmax), voided volume, voiding time and PVR and were recorded in a predesigned data sheet. Selected patients underwent Transurethral Resection of Prostate. They were followed after 1 month and 3 months with same parameter and compared with the baseline values. Results: The baseline international prostate symptoms score (IPSS) in this study was 25.18±1.45. At one month and three months follow up visits after TURP, the IPSS was decreased to 15.0±1.07 and 8.14±0.76 respectively. There was significant improvement of peak urinary flow rate (Qmax) in the postoperative period, at the 1st follow up visit after one month of TURP (15.78±1.42, p<0.001) and at the 2nd follow visit after three months of TURP (18.78, p <0.001). The mean QoL score was 5.30±0.46 before TURP. After one month of TURP it was 3.20±0.45 and after 3 months of TURP it was 1.86±0.57. Conclusion: There is a significant improvement of quality of after TURP. Journal of National Institute of Neurosciences Bangladesh, 2019;5(2): 143-147

scholarly journals Long-Term Followup after Electrocautery Transurethral Resection of the Prostate for Benign Prostatic Hyperplasia

2011 ◽  
Vol 2011 ◽  
pp. 1-6 ◽  
Author(s):  
F. Kallenberg ◽  
T. A. Hossack ◽  
H. H. Woo
Keyword(s):  
Benign Prostatic Hyperplasia ◽  
Transurethral Resection ◽  
Prostatic Hyperplasia ◽  
Urinary Flow ◽  
Complication Rates ◽  
Urethral Strictures ◽  
Voiding Symptoms ◽  
Stricture Rate ◽  
Historic Data

Introduction. For decades, transurethral resection of the prostate (TURP) has been the “gold standard” operation for benign prostatic hyperplasia (BPH) but is based mainly on historic data. The historic data lacks use of validated measures and current TURP differs significantly from that performed 30 years ago.Methods. Men who had undergone TURP between 2001 and 2005 were reviewed. International prostate symptom score (IPSS), quality of life (QOL) and peak urinary flow rate (Qmax⁡), and postvoid residual (PVR) were recorded. Operative details and postoperative complications were documented. Patients were then invited to attend for repeat assessment.Results. 91 patients participated. Mean follow-up time was 70 months. Mean follow-up results were IPSS—7; QoL—1.5;Qmax⁡—23 mL/s; PVR—45 mL. These were an improvement from baseline of 67%, 63%, 187%, and 80%, respectively. Early complication rates were low, with no blood transfusions, TUR syndrome, or deaths occurring. Urethral stricture rate was higher than anticipated at 14%.Conclusion. This study shows modern TURP still produces durable improvement in voiding symptoms which remains comparable with historic studies. This study, however, found a marked drop in early complications but, conversely, a higher than expected incidence of urethral strictures.

scholarly journals Comparative results of the use of transurethral resection and enucleation of the prostate in the treatment of patients with large-sized benign prostatic hyperplasia

2018 ◽  
pp. 50-59
Author(s):  
Д.В. Торбик
Keyword(s):  
Benign Prostatic Hyperplasia ◽  
Treatment Group ◽  
Transurethral Resection ◽  
Clinical Results ◽  
Prostatic Hyperplasia ◽  
Average Score ◽  
Control Group ◽  
Urinary Flow ◽  
Endoscopic Techniques ◽  
Comparative Results

В представленном исследовании анализируются среднесрочные клинические результаты внедрения биполярной техники выполнения трансуретральной резекции и энуклеации в лечении доброкачественной гиперплазии предстательной железы (ДГПЖ) объемом более 80 см3. В исследование включено 84 пациента (основная группа), оперированных методом трансуретральной энуклеации предстательной железы, и 112 пациентов – методом биполярной трансуретральной резекции предстательной железы (контрольная группа). При применении исследуемых эндоскопических методов средний срок послеоперационной катетеризации составил 1,3 суток в основной группе и 1,4 дня в группе контроля, интра- и послеоперационные осложнения (кровотечение, инфекционно-воспалительные осложнения) были единичными, причем меньшая частота встречалась в основной группе. Через 6 месяцев после операции скорость потока мочи возросла на 13,9 мл/с в основной группе и на 10,9 мл/с в группе контроля, средний балл по шкале IPSS в итоге составил 3,2±0,2 балла и 4,1±0,1 балла в основной и контрольных группах соответственно (p<0,05). Полученные результаты в основной группе можно связать с большей радикальностью методики трансуретральной энуклеации простаты (ТУЭБ), объем резидуальной ткани узла в этой группе составил 5,6±0,7 см3 против 14,8±3,2 см3 в группе контроля (p<0,05). Таким образом, метод ТУЭБ может быть рекомендован к освоению врачам-урологам специализированных стационаров, как способ оперативного лечения ДГПЖ крупных размеров. In the present study, the mid-term clinical results of the introduction of the bipolar technique of performing transurethral resection and enucleation in the treatment of benign prostatic hyperplasia (BPH) of more than 80 cm3 are analyzed. The study involved 84 patients who underwent transurethral enucleation of the prostate (treatment group) and 112 patients – bipolar transurethral resection of the prostate (control group). In applying the endoscopic techniques under study, the mean duration of postoperative catheterization was 1.3 days in the treatment group and 1.4 days in the control group; intra- and postoperative complications (bleeding, infectious and inflammatory complications) were incidental with lower occurrence in the treatment group. In 6 months after surgery, the urinary flow rate increased by 13.9 mL/s in the treatment group and by 10.9 mL/s in the control group, the average score on the IPSS scale was 3.2 ± 0.2 points and 4.1 ± 0.1 points in the main and control groups, respectively (p <0.05). The results obtained in the main group can be attributed to the more radical methods of transurethral enucleation of the prostate (TEOB), the volume of residual tissue in this group was 5.6 ± 0.7 cm3 against 14.8 ± 3.2 cm3 in the control group (p<0,05). Thus, the TEOB method can be recommended for mastering by urologists of specialized hospitals as a method of surgical treatment of large-size BPH.

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